As the healthcare debate in Washington, D.C. fizzles out, the states are taking on ambitious proposals to expand insurance coverage.
"The lack of action in Washington is not because of the lack of a problem,” Alan R. Weil, executive director of the National Academy for State Health Policy, told the Los Angeles Times. “It's because of a lack of agreement and, frankly, a lack of consequences for failing to address the issue. At the state level, if you have a Medicaid budget problem or a growing number of uninsured, you have to tackle the issue."
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Consider some of the proposals. In Maine, for example, lawmakers are considering recouping health costs from large employers, such as Wal-Mart, that don't provide adequate health insurance for their employees, Statehouse News Service reported. Employees often turn to the state's subsidized insurance program. Maine senators are looking at a model, which was vetoed in Maryland, that would require companies with more than 10,000 employees to spend 8 percent of their payroll on healthcare benefits or contribute to the state's health program for the poor.
“There's no easy solution to this, but I think people pick on Wal-Mart because they make this great claim they have all these benefits, but I'm not sure their employees can afford all these benefits,” Maine Senate President Beth Edmonds said. “They're not paying their people very much, and with the benefit that's being provided, they still end up in the emergency room … or bankrupting themselves” to pay their health bills.
In Massachusetts, lawmakers want to expand coverage to the state's 500,000 uninsured residents. As part of that effort, lawmakers have proposed charging a payroll tax of 5 to 7 percent on employers that do not provide health insurance for their workers. The plan has sparked opposition from business groups, the Boston Globe reported.
''You've got employers who are facing the highest energy costs, the highest wages, the highest unemployment insurance, the highest real estate costs – and to now put this on? You're going to be in a position where the job growth isn't there, where people aren't making a decision to grow their business," said Bill Vernon, state director of the National Federation of Independent Business.
Initiatives like these back up information gathered by the Kaiser Commission on Medicaid and the Uninsured, which found that 20 states expanded access to healthcare from July 2004 to July 2005. The October study said that 14 states limited access in some way, mainly by raising premiums for programs covering low-income children.
The problem shows no signs of letting up, as employers continue limiting traditional coverage in the face of increasing costs.
"Washington needs to wake up and smell the coffee," said John E. McDonough, executive director of Health Care for All, a consumer group, the Los Angeles Times reported. "Employer-based coverage is melting away like the Arctic ice cap. It is stunning and alarming. The basic underpinnings of the healthcare system are badly eroding."
For now, it appears the states are taking the lead, with interested parties in Washington closely watching their progress.
"You can't fix the whole healthcare system by putting a Band-Aid on each individual hurt, or each individual state," said Sen. Ron Wyden (D-Ore.). "At the end of the day, you are going to have to integrate this very constructive, locally driven brainstorming into a framework that benefits the country as a whole."